High-resolution esophageal manometry in pediatrics: Effect of esophageal length on diagnostic measures

Maartje M.J. Singendonk; Lara F. Ferris; Lisa McCall; Grace Seiboth; Katie Lowe; David Moore; Paul Hammond; Richard Couper; Rammy Abu-Assi; Charles Cock; Marc A. Benninga; Michiel P. van Wijk; Taher I. Omari; European Society for Pediatric Gastroenterology, Hepatology, Nutrition (ESPGHAN) Pediatric Motility Network

doi:10.1111/nmo.13721

High-resolution esophageal manometry in pediatrics: Effect of esophageal length on diagnostic measures

Maartje M.J. Singendonk, Lara F. Ferris, Lisa McCall, Grace Seiboth, Katie Lowe, David Moore, Paul Hammond, Richard Couper, Rammy Abu-Assi, Charles Cock, Marc A. Benninga, Michiel P. van Wijk, Taher I. Omari, European Society for Pediatric Gastroenterology, Hepatology, Nutrition (ESPGHAN) Pediatric Motility Network

College of Medicine and Public Health

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Abstract

Background

High‐resolution esophageal manometry (HREM), derived esophageal pressure topography metrics (EPT), integrated relaxation pressure (IRP), and distal latency (DL) are influenced by age and size. Combined pressure and intraluminal impedance also allow derivation of metrics that define distension pressure and bolus flow timing. We prospectively investigated the effects of esophageal length on these metrics to determine whether adjustment strategies are required for children.

Methods

Fifty‐five children (12.3 ± 4.5 years) referred for HREM, and 30 healthy adult volunteers (46.9 ± 3.8 years) were included. Studies were performed using the MMS system and a standardized protocol including 10 × 5 mL thin liquid bolus swallows (SBM kit, Trisco Foods) and analyzed via Swallow Gateway (www.swallowgateway.com). Esophageal distension pressures and swallow latencies were determined in addition to EGJ resting pressure and standard EPT metrics. Effects of esophageal length were examined using partial correlation, correcting for age. Adult‐derived upper limits were adjusted for length using the slopes of the identified linear equations.

Key Results

Mean esophageal length in children was 16.8 ± 2.8 cm and correlated significantly with age (r = 0.787, P = .000). Shorter length correlated with higher EGJ resting pressure and 4‐s integrated relaxation pressures (IRP), distension pressures, and shorter contraction latencies. Ten patients had an IRP above the adult upper limit. Adjustment for esophageal length reduced the number of patients with elevated IRP to three.

Conclusions & Inferences

We prospectively confirmed that certain EPT metrics, as well as potential useful adjunct pressure‐impedance measures such as distension pressure, are substantially influenced by esophageal length and require adjusted diagnostic thresholds specifically for children.

Original language	English
Article number	e13721
Journal	Neurogastroenterology and Motility
Volume	32
Issue number	1
DOIs	https://doi.org/10.1111/nmo.13721
Publication status	Published - 1 Jan 2020

Bibliographical note

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Keywords

adjustment
Chicago classification
children
high-resolution esophageal manometry
impedance

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10.1111/nmo.13721Licence: CC BY-NC

Published versionFinal published version, 1.45 MBLicence: CC BY-NC

Cite this

Singendonk, M. M. J., Ferris, L. F., McCall, L., Seiboth, G., Lowe, K., Moore, D., Hammond, P., Couper, R., Abu-Assi, R., Cock, C., Benninga, M. A., van Wijk, M. P., Omari, T. I., & European Society for Pediatric Gastroenterology, Hepatology, Nutrition (ESPGHAN) Pediatric Motility Network (2020). High-resolution esophageal manometry in pediatrics: Effect of esophageal length on diagnostic measures. Neurogastroenterology and Motility, 32(1), Article e13721. https://doi.org/10.1111/nmo.13721

@article{ad84b535397e4120b09e90d45d2529a1,

title = "High-resolution esophageal manometry in pediatrics: Effect of esophageal length on diagnostic measures",

abstract = " Background High‐resolution esophageal manometry (HREM), derived esophageal pressure topography metrics (EPT), integrated relaxation pressure (IRP), and distal latency (DL) are influenced by age and size. Combined pressure and intraluminal impedance also allow derivation of metrics that define distension pressure and bolus flow timing. We prospectively investigated the effects of esophageal length on these metrics to determine whether adjustment strategies are required for children. Methods Fifty‐five children (12.3 ± 4.5 years) referred for HREM, and 30 healthy adult volunteers (46.9 ± 3.8 years) were included. Studies were performed using the MMS system and a standardized protocol including 10 × 5 mL thin liquid bolus swallows (SBM kit, Trisco Foods) and analyzed via Swallow Gateway (www.swallowgateway.com). Esophageal distension pressures and swallow latencies were determined in addition to EGJ resting pressure and standard EPT metrics. Effects of esophageal length were examined using partial correlation, correcting for age. Adult‐derived upper limits were adjusted for length using the slopes of the identified linear equations. Key Results Mean esophageal length in children was 16.8 ± 2.8 cm and correlated significantly with age (r = 0.787, P = .000). Shorter length correlated with higher EGJ resting pressure and 4‐s integrated relaxation pressures (IRP), distension pressures, and shorter contraction latencies. Ten patients had an IRP above the adult upper limit. Adjustment for esophageal length reduced the number of patients with elevated IRP to three. Conclusions & Inferences We prospectively confirmed that certain EPT metrics, as well as potential useful adjunct pressure‐impedance measures such as distension pressure, are substantially influenced by esophageal length and require adjusted diagnostic thresholds specifically for children. ",

keywords = "adjustment, Chicago classification, children, high-resolution esophageal manometry, impedance",

author = "Singendonk, {Maartje M.J.} and Ferris, {Lara F.} and Lisa McCall and Grace Seiboth and Katie Lowe and David Moore and Paul Hammond and Richard Couper and Rammy Abu-Assi and Charles Cock and Benninga, {Marc A.} and {van Wijk}, {Michiel P.} and Omari, {Taher I.} and {European Society for Pediatric Gastroenterology, Hepatology, Nutrition (ESPGHAN) Pediatric Motility Network}",

note = "This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.",

year = "2020",

month = jan,

day = "1",

doi = "10.1111/nmo.13721",

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Singendonk, MMJ, Ferris, LF, McCall, L, Seiboth, G, Lowe, K, Moore, D, Hammond, P, Couper, R, Abu-Assi, R, Cock, C, Benninga, MA, van Wijk, MP, Omari, TI & European Society for Pediatric Gastroenterology, Hepatology, Nutrition (ESPGHAN) Pediatric Motility Network 2020, 'High-resolution esophageal manometry in pediatrics: Effect of esophageal length on diagnostic measures', Neurogastroenterology and Motility, vol. 32, no. 1, e13721. https://doi.org/10.1111/nmo.13721

TY - JOUR

T1 - High-resolution esophageal manometry in pediatrics

T2 - Effect of esophageal length on diagnostic measures

AU - Singendonk, Maartje M.J.

AU - Ferris, Lara F.

AU - McCall, Lisa

AU - Seiboth, Grace

AU - Lowe, Katie

AU - Moore, David

AU - Hammond, Paul

AU - Couper, Richard

AU - Abu-Assi, Rammy

AU - Cock, Charles

AU - Benninga, Marc A.

AU - van Wijk, Michiel P.

AU - Omari, Taher I.

AU - European Society for Pediatric Gastroenterology, Hepatology, Nutrition (ESPGHAN) Pediatric Motility Network

N1 - This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - Background High‐resolution esophageal manometry (HREM), derived esophageal pressure topography metrics (EPT), integrated relaxation pressure (IRP), and distal latency (DL) are influenced by age and size. Combined pressure and intraluminal impedance also allow derivation of metrics that define distension pressure and bolus flow timing. We prospectively investigated the effects of esophageal length on these metrics to determine whether adjustment strategies are required for children. Methods Fifty‐five children (12.3 ± 4.5 years) referred for HREM, and 30 healthy adult volunteers (46.9 ± 3.8 years) were included. Studies were performed using the MMS system and a standardized protocol including 10 × 5 mL thin liquid bolus swallows (SBM kit, Trisco Foods) and analyzed via Swallow Gateway (www.swallowgateway.com). Esophageal distension pressures and swallow latencies were determined in addition to EGJ resting pressure and standard EPT metrics. Effects of esophageal length were examined using partial correlation, correcting for age. Adult‐derived upper limits were adjusted for length using the slopes of the identified linear equations. Key Results Mean esophageal length in children was 16.8 ± 2.8 cm and correlated significantly with age (r = 0.787, P = .000). Shorter length correlated with higher EGJ resting pressure and 4‐s integrated relaxation pressures (IRP), distension pressures, and shorter contraction latencies. Ten patients had an IRP above the adult upper limit. Adjustment for esophageal length reduced the number of patients with elevated IRP to three. Conclusions & Inferences We prospectively confirmed that certain EPT metrics, as well as potential useful adjunct pressure‐impedance measures such as distension pressure, are substantially influenced by esophageal length and require adjusted diagnostic thresholds specifically for children.

AB - Background High‐resolution esophageal manometry (HREM), derived esophageal pressure topography metrics (EPT), integrated relaxation pressure (IRP), and distal latency (DL) are influenced by age and size. Combined pressure and intraluminal impedance also allow derivation of metrics that define distension pressure and bolus flow timing. We prospectively investigated the effects of esophageal length on these metrics to determine whether adjustment strategies are required for children. Methods Fifty‐five children (12.3 ± 4.5 years) referred for HREM, and 30 healthy adult volunteers (46.9 ± 3.8 years) were included. Studies were performed using the MMS system and a standardized protocol including 10 × 5 mL thin liquid bolus swallows (SBM kit, Trisco Foods) and analyzed via Swallow Gateway (www.swallowgateway.com). Esophageal distension pressures and swallow latencies were determined in addition to EGJ resting pressure and standard EPT metrics. Effects of esophageal length were examined using partial correlation, correcting for age. Adult‐derived upper limits were adjusted for length using the slopes of the identified linear equations. Key Results Mean esophageal length in children was 16.8 ± 2.8 cm and correlated significantly with age (r = 0.787, P = .000). Shorter length correlated with higher EGJ resting pressure and 4‐s integrated relaxation pressures (IRP), distension pressures, and shorter contraction latencies. Ten patients had an IRP above the adult upper limit. Adjustment for esophageal length reduced the number of patients with elevated IRP to three. Conclusions & Inferences We prospectively confirmed that certain EPT metrics, as well as potential useful adjunct pressure‐impedance measures such as distension pressure, are substantially influenced by esophageal length and require adjusted diagnostic thresholds specifically for children.

KW - adjustment

KW - Chicago classification

KW - children

KW - high-resolution esophageal manometry

KW - impedance

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U2 - 10.1111/nmo.13721

DO - 10.1111/nmo.13721

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SN - 1350-1925

VL - 32

JO - Neurogastroenterology and Motility

JF - Neurogastroenterology and Motility

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M1 - e13721

ER -

High-resolution esophageal manometry in pediatrics: Effect of esophageal length on diagnostic measures

Abstract

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Keywords

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